The House on Wednesday narrowly passed a Republican healthcare package hours after four frustrated GOP members bucked Speaker Mike Johnson and joined with Democrats to force an eventual vote on an extension of expiring Affordable Care Act subsidies.
The group of GOP moderates — Reps. Brian Fitzpatrick, Rob Bresnahan and Ryan Mackenzie of Pennsylvania and Mike Lawler of New York — signed a Democratic discharge petition led by House Minority Leader Hakeem Jeffries, delivering the last of 218 signatures needed to force a vote on a three-year extension of the subsidies. That vote is likely to come in January, after the subsidies expire, though Johnson could expedite it.
All four lawmakers represent competitive districts that could be crucial to Republican hopes of maintaining their narrow majority in the House.
“We have worked for months to craft a two-party solution to address these expiring healthcare credits,” Fitzpatrick said in a statement. “As I’ve stated many times before, the only policy that is worse than a clean three-year extension without any reforms, is a policy of complete expiration without any bridge. Unfortunately, it is House leadership themselves that have forced this outcome.”
The moderates’ rebellion came after GOP leaders effectively blocked an amendment vote to extend the subsidies by insisting that the cost of an extension be offset by other healthcare savings. The House Rules Committee also shut down the moderates’ proposed amendments during debate on the GOP healthcare package and blocked a 2-year extension of the subsidies.
Republican leaders had used a “current policy baseline” this summer to zero out the roughly $4 trillion cost of extending their 2017 tax cuts, but they refused to do the same or waive “pay-for” requirements for a subsidy extension projected to cost $35 billion a year.
The Republican leadership’s plan, passed in a 216-211 vote, would allow the enhanced ACA subsidies to expire as scheduled at the end of the month, affecting some 22 million people enrolled in plans through the Affordable Care Act marketplace.
Instead of extending those Covid-era tax credits, the House Republican bill combines a handful of other policies, including an expansion of access to “association health plans,” which allow employers to join together to buy coverage, as well as funding for “cost-sharing reduction” payments that would help lower-income enrollees afford insurance but make premiums more expensive for others with ACA plans.
The Congressional Budget Office estimated that the Republican bill, called the “Lower Health Care Premiums for All Americans Act,” would lower the federal deficit by $35.6 billion over 10 years but also cut the number of people with health insurance by about 100,000 over the years 2027 through 2035. That’s on top of the roughly 4 million people expected to lose coverage as a result of the expiration of the enhanced subsidies.
The House GOP plan has no real chance of getting through the Senate, but it gives Republicans in the chamber something they can highlight to counter Democratic charges that they were fomenting a healthcare crisis by allowing the subsidies to lapse. Johnson and many others in the party have little interest in helping to shore up the Obama-era health law they say is fundamentally broken, or the Covid-era subsidy enhancements enacted by Democrats.
Republican moderates insisted that the leadership plan wasn’t enough and that allowing the subsidies to lapse would hurt their constituents and prove to be “political malpractice,” setting the stage for midterm election losses by allowing millions of Americans to be hit with soaring healthcare premiums.
Lawler said he wasn’t endorsing the Democratic legislation but that GOP leaders had left the centrists little choice. “I continue to believe any extension should be targeted, fiscally responsible, and include income eligibility limits and safeguards against fraud, similar to the bipartisan discussions underway in the Senate,” he said in a statement. “But when leadership blocks action entirely, Congress has a responsibility to act. My priority is ensuring Hudson Valley families aren’t caught in the gridlock.”
A straight three-year extension of the subsidies, estimated to add about $83 billion to the federal deficit, was already blocked once by Senate Republicans and is likely to fail if brought to another vote in the upper chamber. That means that the real path to a subsidy extension will likely have to involve bipartisan compromise. Senators from both parties have been working on a possible deal, and a bipartisan group of lawmakers reportedly discussed the possibility of using the House Democrats’ bill as the vehicle for an eventual deal.
Another rebuke for Johnson: The speaker has been bombarded with criticism from his own members in recent months and at times has struggled to wrangle his narrow 220-213 majority. Lawmakers have used discharge petitions four times this year to bypass Johnson and force floor votes, deploying a procedural move that only occasionally succeeded prior to this Congress. The latest challenge to Johnson again highlights the divisions in the House and within the GOP conference. “I have not lost control of the House,” the speaker insisted to reporters on Wednesday — but it’s never a good sign to have to answer that question.
The bottom line: The enhanced ACA subsidies are going to expire at the end of the month. Neither the House Republican bill nor Democrats’ three-year subsidy extension can pass the Senate, meaning the pressure is still on lawmakers to find some bipartisan compromise when they reconvene next month.